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Gregson CL, Rehman AM, Rukuni R, Mukwasi-Kahari C, Madanhire T, Kowo-Nyakoko F, Breasail MÓ, Jeena L, Mchugh G, Filteau S, Chipanga J, Simms V, Mujuru H, Ward KA, Ferrand RA. Perinatal HIV infection is associated with deficits in muscle function in children and adolescents in Zimbabwe. AIDS 2024; 38:853-863. [PMID: 37991523 DOI: 10.1097/qad.0000000000003795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
OBJECTIVES To determine how muscle strength, power, mass, and density (i.e. quality) differ between children living with HIV (CWH) and those uninfected, and whether antiretroviral therapy (ART) regime is associated with muscle quality. DESIGN A cross-sectional study in Harare, Zimbabwe. METHODS The study recruited CWH aged 8-16 years, taking ART for at least 2 years, from HIV clinics, and HIV-uninfected children from local schools. Muscle outcomes comprised grip strength measured by hand-held Jamar dynamometer, lower limb power measured by standing long-jump distance, lean mass measured by dual-energy X-ray absorptiometry, and muscle density (reflecting intramuscular fat) by peripheral quantitative computed tomography. Linear regression calculated adjusted mean differences (aMD) by HIV status. RESULTS Overall, 303 CWH and 306 without HIV, had mean (SD) age 12.5 (2.5) years, BMI 17.5 (2.8), with 50% girls. Height and fat mass were lower in CWH, mean differences (SE) 7.4 (1.1) cm and 2.7 (0.4)kgs, respectively. Male CWH had lower grip strength [aMD 2.5 (1.1-3.9) kg, P < 0.001], long-jump distance [7.1 (1.8-12.5) cm, P = 0.006], muscle density [0.58 (0.12-1.05) mg/cm 3 , P = 0.018, but not lean mass 0.06 (-1.08 to 1.21) kg, P = 0.891) versus boys without HIV; differences were consistent but smaller in girls. Mediation analysis suggested the negative effect of HIV on jumping power in boys was partially mediated by muscle density ( P = 0.032). CWH taking tenofovir disoproxil fumarate (TDF) had lower muscle density [0.56 (0.00-1.13)mg/cm 3 , P = 0.049] independent of fat mass, than CWH on other ART. CONCLUSION Perinatally acquired HIV is associated, particularly in male individuals, with reduced upper and lower limb muscle function, not mass. Intra-muscular fat (poorer muscle quality) partially explained reductions in lower limb function. TDF is a novel risk factor for impaired muscle quality.
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Affiliation(s)
- Celia L Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Andrea M Rehman
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health
| | - Ruramayi Rukuni
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, Faculty of Infectious and Tropical Diseases
| | - Cynthia Mukwasi-Kahari
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Radiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Tafadzwa Madanhire
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health
| | - Farirayi Kowo-Nyakoko
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC Lifecourse Epidemiology Centre, Human Development and Health, University of Southampton, Southampton, UK
| | - Mícheál Ó Breasail
- Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Monash Medical Centre, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Lisha Jeena
- Nuffield Department of Medicine, University of Oxford, Oxford
| | - Grace Mchugh
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Suzanne Filteau
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Joseph Chipanga
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Victoria Simms
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health
| | - Hilda Mujuru
- Department of Paediatrics, University of Zimbabwe, Harare, Zimbabwe
| | - Kate A Ward
- Department of Radiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Rashida A Ferrand
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, Faculty of Infectious and Tropical Diseases
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Oliveira VHF, Webel AR, Borsari AL, Cárdenas JDG, Deminice R. Health and sociodemographic factors associated with low muscle strength, muscle mass, and physical performance among people living with HIV. AIDS Care 2023; 35:1863-1873. [PMID: 36404290 DOI: 10.1080/09540121.2022.2147482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 11/09/2022] [Indexed: 11/22/2022]
Abstract
ABSTRACTThis study examined the factors associated with low muscle strength, muscle mass, and physical performance in 331 people living with HIV. Participants completed handgrip as a strength measure, appendicular skeletal muscle mass using bioimpedance analysis, and chair rise was a physical performance measure. Multivariate logistic regression was used to analyze the association between low values on these measures with sociodemographic, HIV-related factors, and comorbidities. Higher body mass index (BMI) (OR = 0.91; CI = 0.86-0.97) and higher CD4/CD8 ratio (OR = 0.38; 95% CI = 0.18-0.82) were associated with decreased likelihood of low handgrip strength. Being non-employed (OR = 2.08; 95% CI = 1.07-4.06), having hypertension (OR = 2.27; 95% CI = 1.13-4.54) and rheumatism (OR = 5.46; 95% CI = 1.68-17.74) increased the chance of low handgrip strength. Higher BMI (OR = 0.43; 95% CI = 0.34-0.56), CD4/CD8 ratio (OR = 0.29; 95% CI = 0.09-0.93), and bioimpedance phase angle (OR = 0.22; 95% CI = 0.12-0.40) were associated with decreased likelihood of low muscle mass. Lastly, having less than eight years of education (OR = 1.87; 95% CI = 1.02-3.41) and being non-employed (OR = 8.18; 95% CI = 3.09-21.61) increased the chance of low chair stand performance. In addition, higher CD4 + lymphocytes count (OR = 0.99; 95% CI = 0.99-0.99) was associated with a decreased likelihood of low chair stand performance. In conclusion, specific and non-specific HIV-related factors are associated with low handgrip strength, low muscle mass, and/or low chair stand performance.
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Affiliation(s)
- Vitor H F Oliveira
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, USA
| | - Allison R Webel
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, USA
| | - Ana Lucia Borsari
- Department of Physical Education, Londrina State University, Londrina, Brazil
| | | | - Rafael Deminice
- Department of Physical Education, Londrina State University, Londrina, Brazil
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Gouvêa-E-Silva LF, Silva CF, Araujo IB, Lima VS, Fernandes EV, Xavier MB. Relationship Between Handgrip Strength and Age in the Body Composition Variables Among People Living with HIV. Curr HIV Res 2022; 20:472-478. [PMID: 36173077 DOI: 10.2174/1570162x20666220927114848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/11/2022] [Accepted: 09/05/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND The study of aging and handgrip strength (HGS) is important to gain knowledge regarding health care and quality of life in people living with HIV (PLHIV). OBJECTIVE The aim of the study is to analyze the relationship between HGS and age in the body composition variables of PLHIV. METHODS The sample consisted of 77 PLHIV, divided into three groups: G40 - PLHIV aged 40-49 years (n=39); G50 - PLHIV aged 50-59 years (n=26); and G60 - PLHIV aged 60-69 years (n=12). Data collection included anamnesis (sociodemographic, clinical, and laboratory information), physical assessment (body composition and HGS), and physical activity level. Data were analyzed by descriptive and inferential statistics. RESULTS It was noted that men, compared to women, are 5.85 times more likely to present adequate HGS (p<0.001). In addition, adequate HGS was associated with adequate values of body mass index (p<0.001), waist circumference (p<0.001), and fat percentage (p<0.001). The G40 and G50 groups, in relation to the G60, were associated with adequate abdominal circumference (p=0.04). CONCLUSION Monitoring the evolution of HGS in PLHIV, over time, makes it possible to infer about body fat and muscle mass, in order to propose prevention actions and guidelines to prevent early muscle loss, the development of overweight/obesity, and abdominal obesity.
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Affiliation(s)
- Luiz Fernando Gouvêa-E-Silva
- Universidade Federal de Jataí, Laboratório de Anatomia Humana e Comparativa, Jataí, Goiás, Brazil.,Universidade Federal do Pará, Núcleo de Medicina Tropical, Belém, Pará, Brazil.,Universidade do Estado do Pará, Centro de Ciências Biológicas e da Saúde, Belém, Pará, Brazil
| | - Camila Ferreira Silva
- Universidade Federal de Jataí, Laboratório de Anatomia Humana e Comparativa, Jataí, Goiás, Brazil
| | | | - Vitória Souza Lima
- Universidade Federal de Jataí, Laboratório de Anatomia Humana e Comparativa, Jataí, Goiás, Brazil
| | | | - Marília Brasil Xavier
- Universidade Federal do Pará, Núcleo de Medicina Tropical, Belém, Pará, Brazil.,Universidade do Estado do Pará, Centro de Ciências Biológicas e da Saúde, Belém, Pará, Brazil
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Hegelund MH, Faurholt-Jepsen D, Abdissa A, Yilma D, Andersen ÅB, Christensen DL, Wells JC, Friis H, Girma T, Olsen MF. Inflammatory markers as correlates of body composition and grip strength among adults with and without HIV: A cross-sectional study in Ethiopia. Eur J Clin Nutr 2022; 76:973-978. [PMID: 35022553 DOI: 10.1038/s41430-021-01056-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 11/21/2021] [Accepted: 11/30/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Changes in body composition and muscle strength are common among individuals with HIV. We investigated the associations of inflammation with body composition and grip strength in adults with and without HIV. METHODS Cross-sectional study among Ethiopian treatment-naïve individuals with and without HIV. Fat mass and fat-free mass adjusted for height (kg/m2) were used as indicators of body composition. RESULTS 288/100 individuals with/without HIV were included between July 2010 and August 2012. Females with HIV had lower fat mass index (FMI) and fat-free mass index (FFMI) than females without HIV, whereas no difference was seen between males with and without HIV. Males and females with HIV had lower grip strength than their counterparts without HIV. Serum alpha-1-acid glycoprotein (s-AGP) was negatively correlated with FMI (-0.71 kg/m2, 95% CI: -1.2; -0.3) among individuals with HIV, and those with HIV and serum C-reactive protein (s-CRP) ≥ 10 mg/l had 0.78 kg/m2 (95% CI -1.4; -0.2) lower FMI than those with s-CRP < 10 mg/l. In contrast, s-AGP was positively correlated with FMI (2.09 kg/m2, 95% CI 0.6; 3.6) in individuals without HIV. S-CRP and AGP were negatively associated with grip strength in individuals with HIV, while no correlation was observed among those without HIV. CONCLUSION Inflammation was positively associated with FMI in individuals without HIV while it was negatively associated with FMI in those with HIV, indicating that inflammation may be one of the drivers of depleting energy reserves among treatment-naïve individuals with HIV. Inflammation was associated with decreased muscle quantity and functional capacity among individuals with HIV, but not in those without HIV.
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Affiliation(s)
- Maria H Hegelund
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark. .,Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, Hillerød, Denmark.
| | | | - Alemseged Abdissa
- Department of Laboratory Sciences and Pathology, Jimma University, Jimma, Ethiopia
| | - Daniel Yilma
- Department of Internal Medicine, Jimma University Specialized Hospital, Jimma, Ethiopia
| | - Åse B Andersen
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Dirk L Christensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jonathan C Wells
- Childhood Nutrition Research Centre, Population Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College of London, London, UK
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Tsinuel Girma
- Department of Paediatrics and Child Health, Jimma University Specialized Hospital, Jimma, Ethiopia
| | - Mette F Olsen
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark.,Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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Mwangala PN, Mabrouk A, Wagner R, Newton CRJC, Abubakar AA. Mental health and well-being of older adults living with HIV in sub-Saharan Africa: a systematic review. BMJ Open 2021; 11:e052810. [PMID: 34551953 PMCID: PMC8461287 DOI: 10.1136/bmjopen-2021-052810] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/06/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE In this systematic review, we aimed to summarise the empirical evidence on common mental disorders (CMDs), cognitive impairment, frailty and health-related quality of life (HRQoL) among people living with HIV aged ≥50 years (PLWH50 +) residing in sub-Saharan Africa (SSA). Specifically, we document the prevalence and correlates of these outcomes. DESIGN, DATA SOURCES AND ELIGIBILITY CRITERIA The following online databases were systematically searched: PubMed, CINAHL, PsycINFO, Embase and Scopus up to January 2021. English-language publications on depression, anxiety, cognitive function, frailty and quality of life among PLWH50+ residing in SSA were included. DATA EXTRACTION AND SYNTHESIS We extracted information, including study characteristics and main findings. These were tabulated, and a narrative synthesis approach was adopted, given the substantial heterogeneity among included studies. RESULTS A total of 50 studies from fifteen SSA countries met the inclusion criteria. About two-thirds of these studies emanated from Ethiopia, Uganda and South Africa. Studies regarding depression predominated (n=26), followed by cognitive impairment (n=13). Overall, PLWH50+ exhibited varying prevalence of depression (6%-59%), cognitive impairments (4%-61%) and frailty (3%-15%). The correlates of CMDs, cognitive impairment, frailty and HRQoL were rarely investigated, but those reported were sociodemographic variables, many of which were inconsistent. CONCLUSIONS This review documented an increasing number of published studies on HIV and ageing from SSA. However, the current evidence on the mental and well-being outcomes in PLWH50+ is inadequate to characterise the public health dimension of these impairments in SSA, because of heterogeneous findings, few well-designed studies and substantial methodological limitations in many of the available studies. Future work should have sufficiently large samples of PLWH50+, engage appropriate comparison groups, harmonise the measurement of these outcomes using a standardised methodology to generate more robust prevalence estimates and confirm predictors. PROSPERO REGISTRATION NUMBER CRD42020145791.
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Affiliation(s)
- Patrick Nzivo Mwangala
- Department of Clinical Research (Neurosciences), KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- University of the Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Adam Mabrouk
- Department of Clinical Research (Neurosciences), KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ryan Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Parkton, Gauteng, South Africa
| | - Charles R J C Newton
- Department of Clinical Research (Neurosciences), KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Amina A Abubakar
- Department of Clinical Research (Neurosciences), KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
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6
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Erlandson KM, Piggott DA. Frailty and HIV: Moving from Characterization to Intervention. Curr HIV/AIDS Rep 2021; 18:157-175. [PMID: 33817767 PMCID: PMC8193917 DOI: 10.1007/s11904-021-00554-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW While the characteristics associated with frailty in people with HIV (PWH) have been well described, little is known regarding interventions to slow or reverse frailty. Here we review interventions to prevent or treat frailty in the general population and in people with HIV (PWH). RECENT FINDINGS Frailty interventions have primarily relied on nonpharmacologic interventions (e.g., exercise and nutrition). Although few have addressed frailty, many of these therapies have shown benefit on components of frailty including gait speed, strength, and low activity among PWH. When nonpharmacologic interventions are insufficient, pharmacologic interventions may be necessary. Many interventions have been tested in preclinical models, but few have been tested or shown benefit among older adults with or without HIV. Ultimately, pharmacologic and nonpharmacologic interventions have the potential to improve vulnerability that underlies frailty in PWH, though clinical data is currently sparse.
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Affiliation(s)
- Kristine M Erlandson
- Department of Medicine, Division of Infectious Diseases, University of Colorado-Anschutz Medical Campus, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO, 80045, USA.
- Department of Epidemiology, Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, USA.
| | - Damani A Piggott
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD, USA
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Oliveira VHF, Borsari AL, Webel AR, Erlandson KM, Deminice R. Sarcopenia in people living with the Human Immunodeficiency Virus: a systematic review and meta-analysis. Eur J Clin Nutr 2020; 74:1009-1021. [PMID: 32341489 DOI: 10.1038/s41430-020-0637-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 01/05/2023]
Abstract
People living with HIV (PLHIV) experience greater loss of muscle mass and function than people without HIV. However, HIV is not routinely recognized as a sarcopenia risk factor outside of HIV literature. The purposes of this study were to establish the prevalence and predictors of sarcopenia among PLHIV, and to compare the prevalence of sarcopenia among PLHIV and people without HIV. A systematic literature search of the PubMed, Embase, Cinahl, and Scielo databases was performed following PRISMA and MOOSE guidelines. Identified articles were included if they evaluated sarcopenia among PLHIV using either the presence of low muscle mass only or low muscle mass in association with low muscle function. The pooled prevalence of sarcopenia among PLHIV and the odds ratio for sarcopenia in PLHIV compared with controls were calculated. From 13 studies and 2267 participants, the prevalence of sarcopenia among PLHIV was 24.1% (95% CI = 17.8-31.0%). PLHIV presented 6.1 greater odds (95% CI = 1.1-33.5) of sarcopenia compared with people without HIV, matched by age, sex, BMI, and ethnicity. Longer exposure to specific HIV drugs, tobacco and alcohol, lower education and employment rates, and greater HIV duration were associated with sarcopenia. In conclusion, PLHIV had a high prevalence of sarcopenia, related to both HIV and non-HIV risk factors. HIV should be considered a risk factor for sarcopenia in the general population. CRD42019131449.
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Affiliation(s)
- Vitor H F Oliveira
- Department of Physical Education, State University of Londrina, Londrina, Paraná, Brazil.
| | - Ana L Borsari
- Department of Physical Education, State University of Londrina, Londrina, Paraná, Brazil
| | - Allison R Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | | | - Rafael Deminice
- Department of Physical Education, State University of Londrina, Londrina, Paraná, Brazil
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Jimenez-Morales J, Arias-Vázquez PI, Tovilla-Zárate CA, Gutiérrez-Hernández G, Dávila-Tejeida AB, Ortega-Corzo Y, Hernández-Gil KDC, González-Castro TB, López-Narváez ML, Juárez Rojop IE. Association between physical capacity of individuals with HIV/AIDS and markers of disease progression. Ann Phys Rehabil Med 2020; 63:249-251. [PMID: 32057989 DOI: 10.1016/j.rehab.2020.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Janeth Jimenez-Morales
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, Mexico
| | - Pedro Iván Arias-Vázquez
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, Mexico
| | - Carlos Alfonso Tovilla-Zárate
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, Mexico.
| | - Gabriela Gutiérrez-Hernández
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, Mexico
| | | | - Yarenny Ortega-Corzo
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, Mexico
| | - Karen Del Carmen Hernández-Gil
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, Mexico
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Bhima K, Mtimuni B, Matumba L. Tackling protein-energy under-nutrition among resource-limited people living with HIV/AIDS in Malawi using soybean-enriched maize-based stiff porridge (nsima): A pilot study. Nutr Diet 2019; 76:257-262. [PMID: 31012256 DOI: 10.1111/1747-0080.12539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/10/2019] [Accepted: 03/17/2019] [Indexed: 11/28/2022]
Abstract
AIM The Ministry of Health in Malawi has scaled-up antiretroviral therapy (ART) for HIV infection. However, the majority of Malawians heavily depend on maize-based stiff porridge (nsima), a protein-deficient staple, a practice that exacerbates wasting and ultimately compromises the success of ART programming. This pilot study was conducted to evaluate the efficacy of utilising soybean-enriched nsima as a strategy for managing HIV-related wasting among resource-poor people. METHODS A before and after designed study involving 25 wasted (<18.5 BMI (body mass index)) to normal (18.5-24.9 BMI) HIV-positive rural women (21-40 years) taking ART and provided with soybean-maize flour (20 kg/month for 3 months) prepared from hydrothermally treated soybeans and maize in the ratio of 1:4 (wt/wt). Anthropometry was performed at baseline and every month for the 3-month study period. Paired sample t-tests were used to test for changes in body mass and BMI between baseline and the subsequent months. RESULTS Statistically significant (P < 0.001) cumulative mean weight gain for the first, second and third month of the study were 1.6, 2.1 and 2.9 kg, respectively. The number of participants with low BMI reduced from 6/25 at baseline to 2/25 after 3 months, and the mean BMI improved from 19.3 to 21.1 kg/m2 . CONCLUSIONS Nsima prepared from a blend of maize and hydrothermally treated soybeans could feasibly be used to prevent and manage wasting among resource-poor people living with HIV/AIDS in sub-Saharan Africa who rely on maize as a major staple.
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Affiliation(s)
- Karen Bhima
- Department of Human Nutrition and Health, Lilongwe University of Agriculture and Natural Resources (LUANAR), Lilongwe, Malawi
| | - Beatrice Mtimuni
- Department of Human Nutrition and Health, Lilongwe University of Agriculture and Natural Resources (LUANAR), Lilongwe, Malawi
| | - Limbikani Matumba
- Food Technology and Nutrition Group, Lilongwe University of Agriculture and Natural Resources (LUANAR), Lilongwe, Malawi
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Effects on body composition and handgrip strength of a nutritional intervention for malnourished HIV-infected adults referred for antiretroviral therapy: a randomised controlled trial. J Nutr Sci 2019; 8:e19. [PMID: 31143445 PMCID: PMC6522867 DOI: 10.1017/jns.2019.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 01/12/2023] Open
Abstract
Lipid-based nutrient supplements (LNS) may be beneficial for malnourished HIV-infected patients starting antiretroviral therapy (ART). We assessed the effect of adding vitamins and minerals to LNS on body composition and handgrip strength during ART initiation. ART-eligible HIV-infected patients with BMI <18·5 kg/m2 were randomised to LNS or LNS with added high-dose vitamins and minerals (LNS-VM) from referral for ART to 6 weeks post-ART and followed up until 12 weeks. Body composition by bioelectrical impedance analysis (BIA), deuterium (2H) diluted water (D2O) and air displacement plethysmography (ADP), and handgrip strength were determined at baseline and at 6 and 12 weeks post-ART, and effects of LNS-VM v. LNS at 6 and 12 weeks investigated. BIA data were available for 1461, D2O data for 479, ADP data for 498 and handgrip strength data for 1752 patients. Fat mass tended to be lower, and fat-free mass correspondingly higher, by BIA than by ADP or D2O. At 6 weeks post-ART, LNS-VM led to a higher regain of BIA-assessed fat mass (0·4 (95 % CI 0·05, 0·8) kg), but not fat-free mass, and a borderline significant increase in handgrip strength (0·72 (95 % CI −0·03, 1·5) kg). These effects were not sustained at 12 weeks. Similar effects as for BIA were seen using ADP or D2O but no differences reached statistical significance. In conclusion, LNS-VM led to a higher regain of fat mass at 6 weeks and to a borderline significant beneficial effect on handgrip strength. Further research is needed to determine appropriate timing and supplement composition to optimise nutritional interventions in malnourished HIV patients.
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Key Words
- ADP, air displacement plethysmography
- ART, antiretroviral therapy
- Antiretroviral therapy
- BIA, bioelectrical impedance analysis
- Body composition
- CD4, cluster of differentiation 4
- D2O, deuterium (2H) diluted water
- FFMI, fat-free mass index
- FMI, fat mass index
- Handgrip strength
- LNS, lipid-based nutrient supplement
- LNS-VM, lipid-based nutrient supplement with added vitamins and minerals
- Malnutrition
- Minerals
- NUSTART, Nutritional Support for African Adults Starting Antiretroviral Therapy
- Vitamins
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Lédo AP, Rodriguez-Prieto I, Lins L, Neto MG, Brites C. Association Between Health-Related Quality of Life and Physical Functioning in Antiretroviral-Naive HIV-Infected Patients. Open AIDS J 2018; 12:117-125. [PMID: 30369996 PMCID: PMC6182873 DOI: 10.2174/1874613601812010117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 08/24/2018] [Accepted: 09/06/2018] [Indexed: 12/31/2022] Open
Abstract
Background: Poor functional status can significantly affect Health-Related Quality of Life (HRQoL) of HIV patients. However, there is scarce information on the functional profile of such patients before starting antiretroviral therapy (ART). Objective: To estimate the association between health-related quality of life and physical functioning in Antiretroviral-Naive HIV-infected patients. Methods: We conducted a cross-sectional study with HIV-infected patients older than 18 years, and naïve to antiretroviral therapy. The patients were evaluated for functional profile by pulmonary function (forced vital capacity, forced expiratory volume at one second, and Tiffeneau index), handgrip strength, and six-minute walk test in a cross-sectional study. HRQoL was evaluated by the 36-Item Short-Form Health Survey and its Physical (PCS) and Mental (MCS) Component Summaries. Multiple linear regression analyses were used to evaluate the association of predictor variables with PCS and MCS scores. Results: We found lower HRQoL among females patients, with far below average impairment of mental health component. Both male and female patients presented lower 6MWD function test values. Patients with dynapenia were older than patients without it, presented lower PCS mean score, lower family income, poor 6 MWD function test, lower FVC, and lower FEV1 t. Multivariable logistic regression analyses showed that Grip Strength, age and family income were predictor variables for Physical component of HRQoL. Female gender and smoking habit were predictive for the mental component of HRQoL. Conclusion: HRQoL in HIV, drug-naïve patients is predicted by level of dynapenia, smoking, income and gender. Therefore, lifestyle changes and active exercising can help to improve HRQoL in such patients.
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Affiliation(s)
- Ana Paula Lédo
- School of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Liliane Lins
- School of Medicine, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Carlos Brites
- Research Laboratory of Infectious Diseases, Edgard Santos Federal University Hospital, Salvador, Bahia, Brazil
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